Yoga and Chronic Pain

I teach yoga as part of a chronic pain management and rehabilitation program through Kaiser. I asked one of the psychologists to write me a post that explains how chronic pain occurs. Here is the post from our wonderful Dr. Cassie Palermo:

Artwork by George Camacho

"From the first time that I practiced yoga, I was drawn to it. I appreciated the centering, calming, meditative aspect of it. It provides me with a path back to equilibrium when I lose my way. At times I feel compelled to prove my worth – both to myself and my team, as I judge myself against the more seasoned professionals with whom I work. I also lose balance when I strive for "more" and overdo it in my daily routine, and this imbalance takes me out of the moment. With its emphasis of "keeping my yoga on my own mat," focusing on my breath, and being aware of my body movement, posture, and alignment, I practice what I need to restore my sense of balance.

A year or two after I began incorporating yoga into my own routine, yoga became part of my work, as well. I am a psychologist in a chronic pain program and the program now includes a yoga component. It turns out that yoga, among other smooth and gentle movement practices, is a healing approach for the management of chronic pain.

I say "it turns out," not because this discovery is coincidental, but because I have not always known as much about chronic pain and its management as I do now. What I have learned has come from observing the patients in the pain program and doing my own research.

Chronic pain is essentially a disorder of the central nervous system, 

though it becomes quite complex when looking at all that is involved in the way the brain processes pain. However, we must first understand that pain actually serves a purpose.

We are hardwired to interpret signals – sent by nerve endings – as pain, in order to avoid physical damage and/or death. For example, if we put our hand on a burner we do not initially know is hot, we are able to respond by pulling our hand away before we consciously become aware that the burner will indeed singe our skin. Likewise, when something startles us, our system shows a response before we make sense of what has caused the alarm. Once we realize that a friend has jokingly jumped out to scare us, we then experience our rapid heart rate, our tense muscles, and the surge of adrenaline that is already starting to drain. When we feel this, we are experiencing the sensations related to the "fight or flight" response.

In this automatic response, the central nervous system receives input that that there is danger and the potential for harm, and takes action to either gear up and fight to protect, or take flight to distance or avoid. Our brain, part of the central nervous system, is wired so we do not have to wait to consciously weigh our options of what to do. Before it's at the conscious level, our brain sends signals to increase heart rate, make our breath more shallow and rapid, decrease blood flow to the extremities so more is available for the vital organs, speed up our thoughts within the primal part of the brain focused on survival, increase adrenaline to delay the sense of pain and provide a surge of energy, and tense our muscles so as to gear up to meet the situation.

This happens with acute pain situations, such as putting your hand on a burner. Unfortunately, this also occurs with chronic issues, such as spinal stenosis, arthritis, degenerative disc disease, and multiple sclerosis

Since the trigger for danger is always present (chronic in nature, i.e. cannot be cured), the signals are continually being sent, translated as pain, and the central nervous system is responding with the fight or flight response. Right idea but wrong situation since, with the above-named issues, we cannot figuratively remove our hand from the burner nor is there necessarily further damage being done.

Chronic pain is the constant signaling of danger, resulting in over activity of the central nervous system and the fight or flight response.

So, what can we do to deal with this automatic response? We actually have more control over our brains than we originally thought, and we can initiate the opposite (parasympathetic) response in our nervous system – and initiate it earlier and earlier, to catch and reverse these survival responses in order to return our system to a calmer, more sustainable state of operation. Practices like yoga, meditation, QiGong, and changing our thinking patterns do just that.

Seeing this transformation among the patients enrolled in the pain management program is profoundly rewarding. Having yoga be a part of that transformation reminds me of my own practice. I'm included in a larger system of change, and that encourages me that my part of the whole is enough; it brings me peace and balance, and makes my job worth doing."

Announcements:

• Sunday, June 23rd: Lorien will be offering restorative yoga demonstrations as part of Kaiser's Seeds of Hope Cancer Survivor Day. See Events page for info.
• Lorien's Healing Yoga for Wellness DVD is out! Go to Amazon to order yours today!

Working With Vets

I am honored that I get to work with an amazing teacher, Joanne Varni. She is dedicated, professional, compassionate and fearless. I'm sharing her recent blog post that describes her experience working with veterans, how people view pain and what it's like to live without the ego. You can learn more about Joanne from her website: http://joannevarni.com/

"Each week, I look forward to Fridays, when I get to spend a good portion of my day at the VA in Palo
Alto, teaching yoga.  I teach at the in-patient part of the hospital to mostly men and, sometimes, a few women veterans who have substance abuse issues as well as other emotional and mental health challenges.  I get a range of people of all ages, genders, and physical abilities.  Sometimes the classes are quiet and the attendees simply listen to my instruction and sometimes there is playful banter between the vets in the class and between them and me as well (and maybe some colorful language from time to time).

There are many reasons why I am grateful to be teaching to this audience.  For starters, the vets who are in this part of the hospital go there voluntarily, meaning that they know they are not well, so they go to the hospital and check themselves in.  Once there, they stay until they are told it's time to leave (which can be five weeks or more).  For some, staying is difficult.  For others, the leaving is difficult, because they thrive on the structure that is offered to them in this setting.

A few weeks ago, I was telling the group, as I do every week, that I would rather they not be in pain during class (we all suffer enough), and if something didn't feel right to please tell me so that I could give them an alternative posture.  As I was suggesting this at the beginning of a session, one of the vets said,

"pain is weakness leaving the body."

I was kind of speechless (yes, unusual for me) and humbled because I came face to face with their vulnerability. And I realized, it takes a lot for these men to attend a class taught by a woman doing a modality that isn't considered tough (at least when you compare it the boot camp they had to go through when they enlisted), and that it must take an enormous amount of courage to show up at all.  All of them are in some sort of physical, emotional, or mental pain.  There are those who can barely sit still and those who can barely move.  The vets who think yoga is for the weak rib some of the guys, but they come anyway. Why do they come?

Many of them are simply tired of being sick and tired and really just want to feel better.  So they are willing to try anything.  

Knowing this, my intention every week is to offer them something, anything, to make them feel better - even if just for a moment.  I do my best to let them know that I see them and that they matter.  The vets don't have to attend, but the ones who do usually come back.  And sometimes vets come and go throughout the class.

It doesn't matter to me if they stay for a few minutes or the entire time.  I am there to serve them.  

I get so much out of this experience, and feel fortunate that I get to start my weekend this way… I am honored that I get to work with them and maybe give them a sense of peace if only for one breath."

Fascia, Our Body’s Infrastructure

As a yoga teacher, I get asked many questions about pain. A common one is:

Why does an injury in one part of my body present pain in an entirely different part?

Logic would dictate that the area where you feel pain is the site of the injury or issue, but that doesn't always occur. 

If you’ve never experienced sensation that originates far from where it presents, then try this: open your mouth and place your right hand on your lower jaw bone; slide your jaw into your hand, but resist against it with your hand… and notice where you feel the sensation. Yes, there’s some feeling around the connection of your hand and jaw, but mostly you’ll feel this along the left side – the side where your hand isn’t. Why is that?

To answer that, think of Spider-Man’s costume, a tight second skin with a web design all over it. When he moves, the lines of the webs shift and move with him. Now, picture that web design under your skin, not on top of it. Each line of the webs are connected to each other, so when one spot tightens, tangles or is knotted (as in scar tissue), the rest of the web is affected - and the web is extremely sensitive. 

That web is called fascia, which is a type of connective tissue. These tissues range from light, easily affected “fuzz” to ropey, dense fibers. The following video shows some of the fascia in the forearm.

As the video shows, this web of fascia provides a container for nerves, blood and lymph vessels. When the fascial web contracts, we experience constriction on the nerves, in the blood vessels and the lymphatic system. Too much of this contraction may affect our systems in the following way:

• pain response and coordination
• circulation
• immune system

How do we loosen, untangle or release the adhesions in the fascial body? Massage is one method. Passive resistance through gentle yoga poses can also help, as well as tools that reduce overall stress, such as mindfulness and breathing exercises.

The next time you feel a pain response, ask yourself,

Where does this really come from?

You may be surprised by the answer, or you may not if your "Spidey-sense" is alert!

Announcements:

• Hear Lorien's interview on the Transformational Power of Yoga Telesummit.
• Next Kaiser Restorative Yoga for Cancer Survivorship 6-week series begins June 12 (ends July 24, no class July 3). Call 408-366-4284 to register.
• Tuesday, June 4th: Lorien will be offering gentle yoga demonstrations as part of Stanford's Cancer Survivor Celebration week. See Events page for info.
• Sunday, June 23rd: Lorien will be offering restorative yoga demonstrations as part of Kaiser's Seeds of Hope Cancer Survivor Day. See Events page for info.
• Stay tuned: Lorien's Healing Yoga for Wellness DVD will be out in June...